Action Points

Men who adhered to the Dietary Approaches to Stop Hypertension (DASH) diet significantly lowered their risk of gout.

Note that the study suggests that the DASH diet could offer an attractive preventive dietary approach for the risk of gout.

Men who adhered to the Dietary Approaches to Stop Hypertension (DASH) diet significantly lowered their risk of gout, analysis of data from a large prospective study found.

Among 44,444 men enrolled in the Health Professionals Follow-up Study and followed for up to 26 years, there were 1,731 cases of incident gout, according to Hyon K. Choi, MD, director of Clinical Epidemiology at Massachusetts General Hospital and Harvard University in Boston, and colleagues.

Those who scored highest for following the DASH dietary pattern had a 32% lower risk for developing gout compared with those who had the lowest DASH scores, with an adjusted relative risk of 0.68 (95% CI 0.57-0.80, P<0.001), the researchers reported online in BMJ.

"The DASH diet could offer an attractive preventive dietary approach for the risk of gout," they wrote.

The prevalence of gout has been on the rise in recent decades, and now approaches 4% in the United States, where the typical Western diet includes large quantities of red and processed meat, sweets, and refined grains, the team noted. "This disease burden [of gout] is further complicated by a high level of cardiovascular metabolic comorbidities (e.g., hypertension in 74% of patients and metabolic syndrome in 63%) and their sequelae (e.g., an increased future risk of myocardial infarction and premature death)."

The conventional approach to risk lowering for gout has been to limit the intake of purines, but that can lead to an increase in the consumption of undesirable foods including refined carbohydrates and trans fats that can contribute to the associated cardiovascular risks.

The DASH diet has been shown to lower blood pressure, with its emphasis on high intake of vegetables and fruit, low-fat dairy products, and avoidance of saturated fat.

A post-hoc analysis of the DASH randomized study found that it also was associated with lowering of serum uric acid among individuals with hyperuricemia. In that analysis, participants on the diet had a 0.35 mg/dL decrease in serum uric acid, and those with hyperuricemia at baseline had a decrease of 1.29 mg/dL.

Therefore, the researchers sought to examine whether the DASH diet could influence the risk of gout in this large prospective cohort, which began in 1986. Every 4 years, participants completed a validated food frequency questionnaire that includes details about consumption of more than 130 foods.

Participants were divided into quintiles according to how they scored on the DASH diet, with intake of fruits, vegetables, legumes and nuts, low-fat dairy items, and whole grains, as well as on low intake of red meat, sweetened drinks, and sodium.

After adjusting for multiple factors including age, body mass index, hypertension, use of diuretics, and intake of coffee and alcohol, the relative risk for incident gout among men in the highest quintile of consumption of a typical Western diet was 1.42 (95% CI 1.16-1.74, P=0.005) compared with those in the lowest quintile.

In additional stratified analyses looking at whether the association between DASH and Western dietary patterns were influenced by hypertension, body mass index, and alcohol use, the results were similar to the main analysis, and no significant interactions were seen.

The American Heart Association endorses dietary approaches similar to the DASH diet for lowering hypertension and improving overall cardiovascular health. Prior studies have reported that the DASH diet also decreases the risks of kidney stones, stroke, and coronary heart disease, which have been linked with elevated uric acid.

"As such, the DASH diet could be useful not only in the prevention of gout and its comorbidities in high-risk patients with hyperuricemia, but also when urate-lowering drugs are not yet indicated in patients with gout (a more frequently encountered scenario in primary care)," Choi's group noted.

Using an approach such as the DASH diet also could be more effective than focusing on specific foods such as those high in purines that increase risk, because "a healthful complete dietary pattern approach such as the DASH diet reflects the way foods are consumed in reality and adoption (by providing comprehensive diet instructions and ongoing support) in both public health and clinical practice."

The researchers said that a strength of the study was its prospective data collection, while a limitation was the inclusion of only men, most of whom were white and older than 40.

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